Course Selection Form
Student Name
First Name
Last Name
Student ID
Grade Level
Term
Fall
Spring
Summer
School Year
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Name
First Name
Last Name
Parent/Guardian hone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Main Course (Please select only 5 courses)
Alternate Course (Please select only 5 courses)
Student Signature
Date Signed
-
Month
-
Day
Year
Date
Parent Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: